Author(s): HERNANDEZ, A., CABANAS-SÁNCHEZ, V., MARTÍNEZ-GÓMEZ, D., Institution: UNIVERSIDAD DE ALMERÍA, Country: SPAIN, Abstract-ID: 1830

INTRODUCTION:
Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide (1). Although both aerobic and muscle-strengthening physical activity (PA) are key modifiable factors in individuals with CVD (2), adherence to these recommendations is low (3). While sex differences in the associations between PA and mortality have been reported in healthy populations (4), it remains unclear whether similar patterns exist among individuals with established CVD. This study examined sex-specific associations of aerobic and muscle-strengthening PA with all-cause mortality in adults with CVD.
METHODS:
Data were obtained from the US National Health Interview Survey (NHIS) cohort, including 48826 adults with pre-existing CVD (myocardial infarction, angina pectoris, coronary heart disease or stroke) interviewed between 1997 and 2018 and followed for mortality through 2019. All-cause mortality was ascertained via linkage to the National Death Index. Leisure-time PA was self-reported and classified according to WHO recommendations as: meeting aerobic PA (≥ 150 min/week of moderate-to-vigorous activity) and meeting muscle-strengthening activity (≥ 2 times/week). Multivariable-adjusted Cox proportional hazards ratio (HR) was used to estimate mortality risk across PA profiles based on guideline recommendations, using those meeting neither recommendation as the reference category. Restricted cubic splines were used to examine dose–response. All analyses were conducted separately in women and men.
RESULTS:
A total of 23710 women (mean age 66.09 years) and 25116 men (mean age 64.87 years) with CVD were followed for a median of 6.63 years (IQR 3.47-11.22), during which 21132 all-cause deaths occurred. Compared with participants meeting neither recommendation, meeting both was associated with the lowest mortality risk in both women (HR 0.70, 95% CI 0.62–0.81) and men (HR 0.65, 95% CI 0.60–0.70). Meeting aerobic recommendations alone was also associated with lower mortality in women (HR 0.75, 95% CI 0.70–0.80) and men (HR 0.72, 95% CI 0.68–0.76), whereas associations for muscle-strengthening activity alone were weaker and not consistently significant. Patterns were similar in women and men (p for interaction >0.05). Spline analyses indicated non-linear dose–response associations, with mortality risk decreasing up to approximately 300-500 min/week of aerobic PA and plateauing thereafter. For muscle-strengthening activity, the lowest risk was observed at approximately 2–3 times/week.
CONCLUSION:
Among adults with CVD, meeting both aerobic and muscle-strengthening PA recommendations was associated with the lowest risk of all-cause mortality. These associations did not differ by sex, supporting the importance of promoting combined PA modalities in secondary prevention in both women and men.
References:
1. Vaduganathan M, et al. (2022)
2. Cao, Z., et al. (2025)
3. Cassidy, S et al. (2018)
4. Ji, Hongwei et al. (2024)